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INSTRUCTIONS 



TO THE 



MEDICAL EXAMINERS 



of 2>Ut«ots 




By 
A. H. BRUMBACK, M. D. 

Medical Director 
1907 






lUfiHARYofCOnCRESS 


Twu CortM Receivad 

SEP 18 I90r 


^ Cepynrm ftrtry 
COPY B. 



Copyright igo/ 



The Northern* Life Insurance Compan' 
of illinois 

First National Bank Bailding 
CHICAGO 



CONTENTS. 

Page 
The Company 

Officers 4 

Seventeen Reasons 27-28 

The Examiner. 
Applicants to Whom You Must Refuse Examinations 6 

-. Fees 26 

Forfeiture of Fee 26 

Illegal Financial Interest in Applicant 26 

Preface 5 

Reports to Home Office 24 

Territory of Authority 26 

The Examination. 

Abdomen 18 

Alcoholic 7 

Amputations 8 

Appearance of Applicant 7 

Blood Vessels 10 

Build 23 

Circulation lO 

Definite Answers 8 

Dimensions 20 

Ears 10 

Eyes 10 

Family History 22 

Genital Organs 19 

Habits 23 

Heart 16 

Height (Standard of) 21 

Injuries 8 

Kidneys 25 

Lungs 15 

Nerves 25 

Occupation 23 

Pensions 7 

Personal History 19 

Pulse 10 

Respiration 12 

Rheumatism 20 

Skin 10 

Signature 23 

Specific Troubles 20 

Summary 24 

Thorax 14 

Tongue 11 

Weight (Standard of) 21 

Women 13 



G. JUANKT J^ JnCK, PBEsident P. C. ULaUESDJR , l?iEe-I»iesiiiart 

LEE F. COLE, Seoetary 

CHARLES R. LAKELET, TisasuKT 

yrTT.T.S M. DA^W^DIS, E. A. S. , E. I A. , Actuary 

A H. ERT7MBACK, M. D., Medical DiBectar 

H^TT.T JA M A.. UDTLE, Counsel EA^^^DJK^ SOsLNETJ , Sagistear 

J H. ^THUM^SOK, Supgrmtendent nf Aggnriffs 

A- A. DeCELLE. Auditor 

^Wakeiey ^ Flick, Ikmkgrs 
P. r. MADBDJ? 



t.i=:f f. COIX 
Sectetar^- . Tite ^ortiteiii Life Insuxanoe C 

CHARLES R. l^TATTELTT 
"Vice-PEBs. Ash Ian r! Exciiangt £^ Savings ^Sank. 

SJ^WEOJS' BENNETT 
wftTHJtyt^A , InteT— Ocsan Componv 

M. A. PATTERSON', A. G. F. A. 
Hjock Tsfanri Svstem 

JULIAN SARJilES 
Aiciii&sct 

J. HENRY E31AT7SE 
Casiiiei, £jans£ Savnigs Bank 

3. S. SLTJMENT HA 1. 
Sonnsnsctisni , BuimenlisiJ l^Bssiicson, ActtoiiEys 



Instructions to Medical Examiners of the Northern 
Life Insurance Company of Illinois. 

Examiners are requested to read carefully the following instruc- 
tions, as familiarity with them will save much unnecessary work 
and needless correspondence. All communications relative to medi- 
cal matters should be addressed to the Medical Director at the Home 
Office. 

We trust that our examiners will read these instructions in the 
same spirit in which they have been written by the Medical Director. 
We would have you feel that we have implicit confidence in your 
integrity and your loyalty to this Company. We know by investiga- 
tion that your medical training and experience in your profession 
have fitted you for the work which we call upon you to do. In putting 
before you these instructions, it is not assuming for a moment that 
you are not familiar with what you will find herein, but is intended 
more as a reminder of what our medical department has found nec- 
essary to take up in correspondence with our examiners. We place 
before you what m.ay seem at first a more lengthy description than 
is necessary, but we honestly believe that a careful study of these 
instructions w411 obviate unnecessary correspondence and delays in 
the Home Office and will facilitate the prompt delivery of policies 
to those justly entitled thereto. 

Answer Fully All Questions. 

While it may seem to you that many of the questions on the 
examination form are trivial and unnecessary, and that perfunctory 
answers now and then may be justifiable, we must ask you not to 
take this view of the matter. Experience has shown the necessity of 
all that the form contains and of a conscientious care on the part 
of the examiner as to the details of the record. But you are not to 
be hampered by the form ; on the contrary you are to look upon it 
as suggestive. It was not devised for the purpose of obtaining a 
fixed amount of information or uniformity in reports, or as a mould 
capable of holding so much and no more. Since you are chiefly 
responsible for the great financial liabilities assumed by the Com- 
pany, and therefore must regard yourselves as officers of the Com- 
pany, it is your obvious duty to give a clear, straightforward, inde- 
pendent, complete and honest estimate of each risk you are called 
upon to judge. 



6 THE XORTHERX LIFE IXSUE_\XCE CO. OF ILLINOIS. 

It is well to bear in mind the fact that your attitude toward an 
applicant is not that of a physician toward his patient : that answers 
will often be given to you reluctanth', and that there will be need of 
all the tact you possess. 

When you are called upon to make examinations, comply witli 
all reasonable requests from the agent for promptness and keep your 
appointment. Delays in insurance are most vexatious. Put your- 
self in the agent's place and remember that delay may mean financial 
loss to him. Do not, however, be hurried in the work itself. Take 
ample time. Look carefully into the moral hazard, for this is per- 
haps the greatest risk an insurance company assumes. Under this, 
generally, may be included character, habits, financial condition, 
insurable interest, and much that is comprehended in the word 
"environment." Examine in private always, and do not permit the 
agent or other persons to be present. 

After your report is finished, review it to make sure of its com- 
pleteness and then send at once to the Home Office. Kindly notify 
the agent that the paper has been forwarded. 

Who Shol'ld Xot Be Examined. 

You should refuse to examine an apphcant who is related to 
you by blood or marriage or an applicant who may make you a ben- 
eficiary under his policy. 

You should refuse to examine an applicant vvho to your knowl- 
edge has been postponed, declined, or limited, or looked upon as a 
sub-standard risk by any Company, Association or Society, unless 
permission for an examination has been obtained from the Home 
Office. 

Neither should you accept a fee from agent or applicant and 
suppress a report. An application once placed in the hands of an 
Examiner cannot be withdrawn. Every examination that you make 
will be paid for b}^ the Company, whether the risk be accepted or not. 

Always refuse to examine an applicant if you happen to know 
that he is an imdesirable risk. Whenever this is the case, or when- 
ever you decide to advise postponement, or declination, or limitation 
as to the kind of policy or amount of insurance, or to withhold your 
final report imtil 3'ou have had an opportunit}* to make a special 
inquiry or investigation, or a re-examination to satisfy yourself on 
a particular point, or to clear away a doubt, do not fail to zvrife at 
once to the Medical Director at the Home Office^ giving details and 
the applicant's full name, age, residence and occupation. 

It is well to have resrard for the instinctive nerv^ousness of some 



INSTRUCTIONS TO MEDICAL EXAMINERS. / 

applicants under examination. You should aim by your manner to 
put the applicant at ease and proceed first to that part of your duties 
which consists of putting the questions and recording the answers, 
reserving the making of the physical examination to the last. If the 
applicant has recently been ill the examination should be postponed 
until recovery is perfect. 

Do Not Judge By Appearances. 

In the matter of physical examinations do not be led by the 
good appearance of the applicant to slight any details, but make your 
examination thorough no matter how sound he may appear or how 
well you may know him. For the practice of auscultation insist on the 
coat, vest and shirts being taken off so no clothing may interfere 
with the sounds of the chest. In the examination of women you 
should be as thorough as in the examination of men. 

In writing up the examination report answer every question 
exactly as asked, and complete answer to each question before pass- 
ing on to the next. Use no ditto marks or dashes, but answer "Yes" 
and "No" to each. Where the answer to a question is "Yes" and 
disease thus admitted, the Examiner should inquire into the clinical 
history of the case and make a brief record of the same at the AP- 
PROPRIATE PLACE UPON THE BLANKS. In doing this you 
should be careful to VERIFY THE DIAGNOSIS, since a layman 
is apt, through ignorance, to give his ailment a wrong name. 

These details are necessary since the EXAMINER ONLY 
sees the applicant and hears his answers, and should endeavor to give 
the Medical Director a mental picture of him, as well as his family 
and personal history. 

If the applicant has applied for a pension, ascertain full partic- 
ulars as to the disabilities alleged, and if in receipt of a pension, the 
disabilities for which he is pensioned, fully describing the same, re- 
membering that any one justly receiving a pension is a poor or sub- 
standard risk and one who is drawing a pension fraudulently would 
defraud the Company if he could. 

Habits in Use of Alcoholics. 

The habits of the applicant relative to the use of alcoholic drinks 
should be carefully inquired into. Convince yourself that the an- 
swers given represent the whole truth. Such terms as "temperate," 
"drink occasionally," "when I feel like it," "as a medicine," etc., have 
but little significance, and will not be accepted. We wish to know 
what a man drinks, how much and how often. The most definite 



8 THE NORTHERN LIFE INSURANCE CO. OF ILLINOIS. 

information on this point is essential. Statistics of mortality prove, 
beyond question, that any excessive use of ardent spirits, malt liquor, 
or other stimulants, even to the extent of being an OCCASIONAL 
habit, makes the risk a bad one for life insurance. 

In amputation or injuries received, care should be taken to ex- 
plicitly state the cause of same, especially in the former case if due 
to disease. Describe fully to what extent locomotion or use of limb 
is impaired, condition of stump and whether artificial limb is worn, 
or cane or other assistance required. 

In recording applicant's answers regarding asthma, pneumonia, 
renal or hepatic colic, etc., if same be admitted, do not be content 
with the symptom.s of the last attack, but see that the number of 
attacks, w4th the date and duration of each, are recorded. Each 
ailment or condition listed on the blank form should be made the sub- 
ject of specific inquiry, the Examiner reading out each title to the 
applicant for definite answer concerning the same. It is not safe 
to accept a sweeping statement that he has never been seriously ill, 
since many conditions having a bearing on insurability, but which 
may not constitute illness, such as an haemoptysis, an otorrhea, a 
fistula, piles, stricture are often forgotten by candidates until inquiry 
is specifically made. 

Examine Applicant's Eyes and Ears Carefully. 

We are especially desirous for the Examiner to watch closely 
for amblyopia or any disease of the eyes. It is very important 
that the applicant's eyes and ears should be carefully examined, 
and if possible make an ophthalmoscopic examination of the 
fundus of the eye in a dark room. In health the optic 
nerve appears as a nearly round or slightly oval disk, situated some- 
what to the nasal side of the eye and varying in color from grayish 
pink to red, the center being whiter and the nasal half the darker 
part. The center of the optic papilla may be even with the surface 
or cupped, and may be stippled or dotted in appearance. The retinal 
arteries emerge from this central spot, and the chief venous trunks 
empty there. The arteries are distinguished from the veins by their 
bright red hue, while the veins are darker in color. In a normal 
eye the veins are about one-third larger than the arteries. Also 
remember that arteries in a normal eye do not pulsate, but pulsa- 
tion of the veins is quite common. The veins are usually more tor- 
tuous than the arteries. The retina is practically transparent so that 
the underlying choroid is seen. In persons with a dark skin the 
retina has a grayish hue in the neighborhood of the papilla, which is 
most marked on its nasal side and sHghtly streaked. 



INSTRUCTIONS TO MEDICAL EXAMINERS. V 

The pathological significance of alterations in these normal ap- 
pearances is very great. Should you find on examining the eye 
ground the head of the optic nerve irregular, the nerve head pro- 
truding or mound like and the arteries going to it are smaller than 
normal or partly concealed, while the veins are enlarged and tor- 
tuous, these are characteristic signs of Optic Neuritis and we should 
always remember that this condition depends upon intraorbital or 
intracranial diseases. In the beginning of said condition, vision is 
often unaffected, but if the lesion be in the cerebellum, sudden blind- 
ness may come on. 

There are a great variety of opinions as to the various forms of 
Neuritis of the optic nerve, and the term Papillitis is more often used 
to signify all forms of Optic Neuritis which we meet with, or they 
may be spoken of as "choked disc." Papillitis is more commonly 
the result of brain tumor than of any other cranial lesion. Another 
fairly common cause of Papillitis is meningeal inflammation, partic- 
ularly about the base of the brain, and Tubercular Meningitis is 
very prone to produce it. Cerebral abscess may also cause this 
change in the optic nerve. 

In addition to the cranial causes of Papillitis we have acute 
febrile disorders, Syphilis, Toxaemia from lead and alcohol, Rheu- 
matism and Anemia. Sometimes they produce an acute or chronic 
retrobulbar-Neuritis. There is nearly always in such cases a large 
central scotoma which causes a failure to recognize color, as for 
example green or red, therefore, we deem it necessary that our exam- 
ining physicians should always give the applicants the color tests. 
The chronic form of retrobulbar-Neuritis is generally the result of 
the excessive use of tobacco and alcohol and produces what is called 
Tobacco-amblyopia or Toxic-amblyopia with failure of vision from 
these causes. Therefore, the Northern Life is very particular that 
Medical Examiners find out definitely to what extent the applicant 
uses tobacco or alcoholic stimulants of any kind. 

By far the most important of these forms of Retinitis from a 
diagnostic standpoint is what is known as Albuminuric-Retinitis or 
that due to Bright's disease. As an example, in addition to the 
flame-like hemorrhagic areas, you will find irregular spatterings of 
white which may be star-shaped. The importance of the discovery 
of such changes is that by it is the first suspicion of renal trouble 
aroused. Retinitis also sometimes results from diabetes. Hem- 
orrhages into the retina with Retinitis usually are the result of 
Septicemia, Ulceration, Endocarditis, Diabetes, Gout and fever of 



10 THE NORTHERN LIFE INSURANCE CO. OF ILLINOIS. 

severe t3-pe. They are also seen in cases of great cardiac hypertro- 
phy with Stenosis. 

It is also important that the Examiner notice closely the iris 
in the applicant's eyes as it often indicates disease in other organs. 
An irregular pupil will indicate an old Iritis which may have been 
produced by specific infection or rheumatism. It should also be 
remembered that cataract often occurs as the result of diabetes- 
mellitus, and that corneal ulceration is often an evidence of "scrofu- 
lous" tendencies, while a distorted pupil due to an old Iritis should 
at once give rise to a suspicion of Syphilis. 

The Ears. 
Sub-acute catarrhal inflammation of the middle ear should be 
careful!}^ looked into so far as the patliologv' of the disease is con- 
cerned. In the great majorit}^ of such cases the inflammation com- 
mences in the naso-pharyngeal space and spreads thence to the 
middle ear through the eustachian tube with more or less sweUing of 
the mucous membrane which lines the middle ear. This may progress 
to the purulent fonii and is usually the result of Scarlet Fever, Small- 
pox, etc. Such purulent inflammation of the middle ear may be 
tubercular or may result in mastoid abscesses, Meningitis and kin- 
dred brain diseases. Therefore, the Northern Life requests that 
you examine patients' ears thoroughly. 

The Skin. 

The Medical Examiner should note carefully the color of the 
skin, eruptions, ulcers and sloughs, scars, sweating, dr3Tiess, oedema 
and hardness ; anesthesia and hemi-anesthesia, paresthesia, hyper- 
esthesia and itching. ]\Iuch information can be obtained by a care- 
ful examination of the skin in many cases of disease. You should 
make note of the color, of the integument, of its general nutrition, 
of its pliability and sensibility. The eye at once takes in any erup- 
tion or scars which may mar its naturall}- smooth surface and as 
eruptions and scars are often the manifestations of more or less 
active systemic disorders, an insight into the presence of internal 
disease may be obtained from them. 

The Circulation. Blood Vessels and Pulse. 

Special attention should be given to the blood vessels and pulse. 
One of the first things that a physician does when he is studying 
the conditions of a patient is to feel the pulse, even if the S3Tiiptoms 
which are present do not indicate circulatory disturbance, because 
the pulse is an index to the condition of the heart, as to its power, its 



INSTRUCTIONS TO MEDICAL EXAMINERS. 11 

valvular and its nervous state. The pulse very often gives us infor- 
mation of the presence of real disease, and it will frequently give us 
a general idea of the tone or degree of the debility of the patient. 
From the pulse we gather valuable information as to the condition 
of the arteries and this is a very important part of the diagnosis. 
To use an old saying, "a man is only as old as his arteries," and if 
h^ is sixty years of age and has good blood vessels, he is, as a rule, 
as young in health as another man of thirty with bad blood vessels, 
because it is by the blood vessels that the tissues of the body are 
nourished, and as life depends upon this process of nutrition, the 
better the vessels the better the vitality. 

First examine the applicant sitting in order to prevent over- 
action of the heart, then immediately standing and always state the 
increase of pulse from sitting to standing. In cases where the pulse 
varies from the normal to any great degree, the Company requires 
that the Medical Examiner have the applicant go through some 
violent form of exercise for a few minutes and then note particular- 
ly the increase of pulse rate. Also in counting the pulse count it for 
the entire minute, not for fifteen seconds only. If you find the 
pulse irregular, listen very carefully over the heart for the several 
valvular sounds and note condition. In any great variation from 
the normal pulse rate, examine at another time. 

The Tongue. 

Note the general appearance of the tongue, its coating, fissures, 
ulcers, eruptions, atrophy, hypertrophy, tremors and spasms. We 
deem the appearance of the tongue indicative of the general con- 
dition of the patient, and it is a valuable diagnostic aid in many 
diseases other than those associated with disorders of the gastro- 
intestinal mucous membrane. The Company asks that you take 
special note of the condition of its surface, its shape as it lies in the 
mouth or is protruded and the character of its movements. Also 
see that it is well protruded and examine the back of it more than 
the tip, as the latter is the part giving the least information. 

Take into consideration the fact that the surface of the tongue 
varies greatly even in health, according to the condition of its 
mucous membrane and the epithelium covering it. The most com- 
mon alterations in its appearances are due to mere superficial coat- 
ings or fur which consists of dead epithelium, micro-organisms of 
many kinds, and abnormally shaped living epithelium. Always bear 
in mind that decayed or ragged teeth or follicular tonsillitis will 
effect the epithelium ; also lack of cleanliness and habits such as 



12 TKE NORTHERN LIFE INSURANCE CO. OF ILLINOIS. 

smoking in which cases the tongue is usually found heavily coated 
in the morning. 

You will note especially that a broad, white, heavy coated, 
moist tongue is often seen in acute articular rheumatism, becoming 
dr}^ if the fever is high and the attack prolonged. Where the tongue 
is excepti(Mially furred or roug^ in appearance, the coating is due 
to abnormally long and projecting papillae, covered by an excess of 
li\dng and dead epithelium, denoting disease of the viscera. This 
condition of the tongue is often found in "scrofulous" subjects. 

Should the tongue be denuded, not only of coating, but in 
addition of its normal epithelium, so that it appears dry, hard and 
harsh to the touch, it denotes, as a rule, grave and advanced disease 
of an exliausting nature, such as renal, hepatic or gastric disorder, 
which may cause the death of the patient This condition of the 
tongue is often seen in advanced Phthisis or Gastric Carcinoma. 

Also if the tongue is bereft of epithelium and is beefy arl rei 
looking, elongated and narrowed and shows a peculiar rou::i::e5S 
Vihen protruded, severe visceral disease of the abdominal organs, 
such as dysenter}-. or hepatic abscesses, or carcinoma, may be sus- 
pected ; also pulmonary tuberculosis or acute peritonitis. 

The color of the tongue itself, aside from the discoloration of 
its epitheliimi is an important diagnostic aid. You will find the 
tongue exceedingl} pale in all forms of anemia, particularly those 
due to a lack of hemoglobin, such as chlorosis or acute anemia from 
hemorrhage and in pernicious anemia when well advanced it has a 
remarkable pallor. It is livid and C3'anotic in cases of pulmonar}^ 
disease interfering with the oxidation of the blood, or in cardiac 
disease with similar difficult}". 

Respir.\tion. 

The functions of breathing and the movements of the chest 
are closely associated. The Company is ver\" particular that the 
Examiner note carefully the number of respirations per minute and 
should the breathing be below twelve or above twentv-one re-ex- 
amine chest and note the number of respirations per minute. In 
men the respiratory movements chiefly affect the lower ribs and the 
abdominal muscles, owing to the fact that as the diaphragm de- 
scends it pushes the abdominal contents downward, thereb}' caus- 
ing abdominal bulging. Please note, however, that in women this 
is not so marked, as the breathing is chiefly costal, the upper part 
of the chest moving more than the lower. 

Also note if abdominal breathing is absent in a man and is 



INSTRUCTIONS TO MEDICAL EXAMINERS. 13 

replaced by breathing of the costal type, you may be assured that 
the movements of his diaphragm are impaired by the pressure of 
fluid in the abdomen (ascites) ; by peritonitis, because of fixation 
of the diaphragm owing to pain, by the presence of large growths 
in the abdomen or by great enlargement of the liver and spleen. 
Other possible causes would be subphrenic abscess or a greatly 
enlarged' cystic kidney or hydronephrosis. 

^ If the costal breathing of a woman is absent, there is nearly 
always some pulmonary cause for it, such as faulty development, 
or if due to disease its absence arises most commonly from tuber- 
culosis or pleurisy or old pleural adhesions which bind down the 
chest wall. 

Dyspnoea will be found in all cases in which the blood can- 
not be provided with sufficient oxygen owing to obstruction to the 
entrance of air into the chest, to spasm of the bronchioles or to the 
excluding of the air vesicles by any form of exudate, catarrhal or 
serous. Bear in mind that these conditions may be primary or sec- 
ondary to disease elsewhere, as in uremia or cardiac disease. In- 
spection of the chest in such cases will show great activity of the 
accessory respiratory muscles such as the sternomastoid, the scaleni, 
the pectoralis and the abdominal recti. You will find the nostrils 
dilated and the face anxious. 

Finally notice the extent of the chest-movements as they will 
be found very slight in the characteristic chest of a person having 
a tendency to tuberculosis, and in the barrel-shaped and rigid chest 
of emphysema of the lungs. Deficient expiration or inspiration is 
not only a predisposing cause for lung disease, but a very important 
diagnostic sign. 

Also notice particularly if one side of the chest moves more 
than the other, if so, you will suspect, in the side which moves slight- 
ly, a predisposition to pneumonia, pleuritis, pleuritic effusion, ad- 
hesion or tubercular consolidation. But always take into considera- 
tion that the patient may have a slightly greater development on one 
side than the other, which may not be due to disease, or he may 
have pursued a trade or occupation causing unilateral hypertrophy. 

Women. 

Women are always less desirable risks than men, probably be- 
cause, in the majority of cases, they are less carefully examined. 
The Northern Life insists that the examination of a woman shall be 
as carefully made as that of a man, and you should insist on the 
removal of her corsets or any other article of clothing which may 



14 THE XORTHZRX LIFE IX5URAXCE CO. OF ILLIXOIS. 

interfere with a careful ph) sical examination. Pregnant women 
should not be examined, and superficial examinations will not be 
accepted by this Company. 

The Thorax. 

The inspection of the normal and abnormal chest ; their topog- 
raphy, alterations and the shape of the thorax, rhythm of the res- 
pirations, characteristic signs and symptoms of the various diseases 
of the thoracic organs. 

As you well know, the chief content of the thoracic cavit>- con- 
sists of vital organs, which are, unfortunately, too often subject to 
disease. A cart: :! study of the signs associated with the normal 
func:: n? of : :t = e arts is, therefore, of great importance, as is also 
that :: :■ t : ::: e :::dicating pathological changes. 

-- i: 5 :r t : :i: :•.: will have applicants present themselves 
witli .veil ir.arkcd objective and subjective s\Tnptoms pointing to 
abnormalities in the organs of the chest, it is also a fact that in 
many others none of these signs will exist, or at least in such an 
indefinite manner that your attention would scarcely be attracted 
thereto, and as a result, important thoracic changes from the normal 
might be overlooked. 

We base our diagnosis of the character of an applicant by the 
changes which we find in the surface of the thorax, as to its con- 
tour, and as to its movements, by the respirator}' and cardiac sounds 
and the other physical signs. We asstmie that our ^ledical Exam- 
iners are perfectiy famihar with and have a clear conception of the 
normal appearance of the chest and of the normal sounds which are 
produced within it, and are able to detect any abnormahties tlierein. 
The configurations of the chest which show a tendency to disease, 
or are the result of attacks of disease, are numerous. 

The most famihar of these and that of the most importance to 
this Company, is the so-called phthisical chest which has been called 
"Alar chest" because the scapula stands out from the back like 
wings. The antero-posterior diameter, particularly in the upper two- 
thirds, is very slight, and instead of convexity in this part there will 
be a flattening or hoUowness. This area scarcely moves in respira- 
tion, but the lower third, which is bulging, moves markedly with the 
respiratory eflForts, as does also the epigastrium. You will find the 
shoulders very sloping and the neck anteriorly receding at the epis- 
temal notch and springing forward towards the "Adam's Apple'' 
and the point of origin, instead of coming forward in a normal curve. 

If on the other hand you find the chest bulges anteriorly and 



INSTRUCTIONS TO MEDICAL EXAMINERS. 15 

posteriorly to such an extent that the antero-posterior diameter is 
greater than or equal to the lateral diameter, and if this bulge is very 
uniform, the shoulders being elevated, the back rounded and the neck 
short in appearance from the raised shoulders, the patient is prob- 
ably a sufferer from emphysema of the lungs. This chest is often 
called the barrel-shaped chest. In this case the chest-wall moves 
very little or not at all with the respiratory movements which are 
cliiefly diaphragmatic. 

Localized bulging of the chest, you will find, results, in its 
most diffused type, from the presence of chronic pleural effusion ; 
bulging of a limited area also arises from cardiac hypertrophy, 
particularly that from aortic aneurism, causing bulging by pressure 
from pericardial effusion, and finally from mediastinal growths. 
Marked bulging over the lower part of the chest on the right side 
should cause you to look for some hepatic affection, as well as 
examine the lungs carefully. If the bulging is low down on the left 
side make a careful examination of the spleen and lower portion of 
the lungs and pleura. 

You will always mark the protrusion of the sternum and the 
cartilaginous portion of the ribs attached to it of the so-called 
''pigeon breast" which is either a result of rickets or the presence 
of some obstruction to respiration of a more or less chronic char- 
acter. Finally unilateral bulging of the chest may be due to 
curvature of the spine, which part of the body should always be 
examined before a diagnosis as to the deformity of the chest is 
attempted. 

The Lungs. 

It is the desire of the Northern Life that you pay particular 
attention to the condition of the lungs, as, incipient Phthisis is easily 
overlooked and is one of the greatest menaces to the safety of a 
Life Insurance Company. In many cases of incipient Phthisis which 
the Life Insurance Physician will come in contact with, the only 
thing which may be demonstrated is a small area of lung tissue in 
which the respiratory sounds are suppressed. This can only be 
ascertained by comparing the corresponding spot in the opposite 
lung. This may be the case before there are any rales. 

The vesicular sounds in the two lungs should compare exactly, 
making due allowance for occupation, except over the apices where 
the sounds are much more intense, less vesicular and the expiratory 
sound more prolonged over the right. This is not as well marked 
in a female as it is in the male. In the female they more nearly 



16 THE MOKTHESW LIFE USrSCirAMCE CO. OF ELLIMOIS. 

ctHTespoed. In the male where the sounds are exacdj alike over the 
apices or the intensitj transposed, you should he very careful and 
make sure that it is not a case of incipient FhlAnsis, or that the 
applicant has not at some time had ^lemnonia or some pofanonaij 
a^ection that has not entirdj cleared np. If in the female there is 
any maiked diSierence in the sounds of the afnces, polmoaary 
trouble or some inflarnmatory condition of a more or less chrcHiic 
character is, as a rule, the causr 

The Tcsicular sounds in : f tr^r: :: ii¥iduals vary markedly in 
intensity, but should be ever/ ' :r :ri over both ^des. It is 
only where there is a -: ?.; ::: /pressed or intensified 

vesicular sounds, the latter kr^Oyvr. .5 : -vesicular respiratioii, 

that is indicatiTe of trouble. Ri s i: -: zi ^re very few and 
very feeble and difficmlt t: t? r : : t : rV : : the character 

of normal vesicular breatiixiig co i^-.z:: - ::-S7 :: v>r?"2ry tuber- 
culosis in its very incipiency. 

You should not CHil: :: t : t ^ :t: : t : :: zom- 

parethe sounds beneath Lie : : ^: r t : : t ::: :. 7 : = ^e5t 
done by having tiie applicant :: i: r : : h = : ^^ : ; : : Lz: :: 
allow you to get a little closer : : : t r : zr.r. 7 i ; : :: : " 

of the lung is a favorite seat :\t : : :: : : : 

In the ]^-actice of percv: - ^ :7:: ^ood, as 

in auscultation, tfie percussior r : ^ : pare 

exactly, except over the apicci ,v^cre i: ^i ::i:rc ::::;;:-:-ci over 
the right apex. 

Palpaticm should always be employed i " - : : -r^ ? : - : = s 5 
it win ccmcur with your other findings ar : r : -: r t ; : i 
due to what you may have overlooked wh: ' z z . ; : : ^ i . : 
and percussion. 

Vocal fremitus is, of course, best n-s-kec : r- :7r ~?:" ~':r?hi 
and in male subjects it is more mark^ 1 vr ^ r ^ : : : Ir. 
fonales there is little or no differencz ::\z ir : 5 r : : 

sides of the chest, even over the api : "'.\z:z ::t : s ts: 

marked over one lung or over a port:;: : :t : ::' _- L : z :: : :t 
position which the individual has asstir: 1 ?.: :: : : vr- 

doubtedly is due to sooie pulmonary ch5.::^t arl i7:.7i 7r iir: ^^ 
lodged into. -pnE Heart. 

Palpation of the chest-wall will also give inf ormaticm as to 
the position and character of the cardiac pulsation. Thus the apex- 
beat of the heart in persons standing erect will usually be felt (in 
persons not inordinately fat, and who are healthy), between the 
fifth and sixth ribs, about two inches to the left of the sternum. 



INSTRUCTIONS TO MEDICAL EXAMINERS. 17 

If the apex-beat is below this region, its depression may be clue 
to enlargement of the heart (hypertrophy or dilatation), to effusion 
in the pericardial sac or pleural cavity on the left side, to pulmonary 
emphysema, causing abnormal descent of the diaphragm and with it 
cardiac hypertrophy. Sometimes tumors in the chest produce a 
similar depression. 

OyT the other hand, if the apex-beat of the heart is felt above 
tlie fifth inter-space, the heart may be raised by pericardial adhesions 
following inflammation, by pleural adhesions or effusions, by ab- 
dominal effusions (ascites), by tumors, distention of the colon, by 
gas and by a great enlargement of the spleen. 

Displacement of the apex-beat to the left is generally associated 
with downward displacement, and is generally due to hypertrophy 
of the left ventricle, to pleural adhesions and particularly to pleural 
effusions on the right side. 

Displacements to the right are due to hypertrophy and dilatation 
of the right ventricle, so that the apex-beat is felt in the epigastrium 
or against the edge of the sternum. Pleural effusion on the left 
side may also cause this displacement. 

The area of the normal apex-beat is about one square inch. In 
disease this area often extends over several square inches, gen- 
erally as the result of hypertrophy and dilatation of the ventricles. 

The strength of the beat in health depends largely upon the 
depth of the chest and the thickness of its walls. In disease it is 
increased in hypertrophy of the heart and decreased in cases of 
feebleness of the heart muscles, by effusions into the pericardium 
and the presence of pulmonary emphysema which causes the pro- 
jection of a part of the enlarged lung between the heart and the 
chest-wall. 

Thrills felt in the chest-wall over the heart may be due to 
abnormalities in the blood-current when valvular disease or aneurism 
is present. You will find thrills in the pericardium or the neigh- 
borhood of the apex in disease of the mitral valve, both regurgitant 
and obstructive, and thrills in the neighborhood of the second right 
costal cartilage indicating aortic lesion, generally that of aortic 
stenosis, of aortitis, or of aortic aneurism. 

When thrills are felt in the tricuspid area, namely, in the mid- 
sternal region or a little to the right of it, the lesion is probably 
tricuspid regurgitation, as tricuspid obstruction is quite rare, or 
aneurism of the descending part of the aorta. 

In this connection, you should remember the pulsation felt in 
the chest-wall in some cases of empyema. However, you will note 



18 THE >70STHE53r LIFE IX5I.-RAXCE CO. OF UXOnHSu 

tliat in nearly even.- instance, this ptilsatioii, ishsn it (xxmrs, is fotmd 
€tti the left sick. Tbis condit: :r 5 ; - : i zod by the inqmlse of the 
heart against the effiT?::"! ?r: : : 3 n :wo forms; first, the infeer- 

nal, in which the ez:. : ::: ::...::.:: ^ heavy in^tilse to the cbest; 
second, the extomal, : /. : .tTt ^ a ptAsatingr tiftumr e* ^ ti ^rBi?^1 to 

the chest-wall. Someiirjiei :^^i .3 c^J.ed polsatiiig- *>Ietiri?T. 

The Aedci-iex axd Aioomecal Yiscej.^. 

The surface of the abdomen changes in thr :. : :t: :..:. :t ." . : 
shape of the abdominal wall, the s^^ and syr. : : _ .= ; : _ : r ?. r t : : 
the abdominal organs. The Conqiany ezr-z.': .3 Z :: : tts :: 
ascertain the conditiosi of the abdofmnal c :r:Tr:5 
specticHi, palpitation, percns^on and ansct: : 

always bear ia. mind that tfie abdominal : ::-:\ : ^ > 

ward or protruded by many perfectly ncr:::.^ ii.iTS :..: ir. 

mrasnal amomit of fat in the onaentum, pregnancy and an a: :.:".: - 
lation of food in the stomach after a heayy meaL 

Yon win note also the abnormal degree of cofivexity r. :?.5t5 
in which ascites is present, wben the stomach and bo-r':- irt t:z- 
tented with gas (t^Tupanites), and when any of the c-^-:.r.r :': ::.i 
in the peritoneal cavity are tdie seat of swellings cr :; ::- ::" 
large size. Such cases are often fotmd in scfofnla or : : r 

of the mesenteric glands and in those cases which 5 .:z:-r :r : ~ 
chronic gastro-intestinal catarrh. 

If on the other hand the beBy-waH is retracted. :::::.- t :r 
scaphoid as it is sofnetimes caDed) yon will I^:'-: :':- ::- .z- :r. 
abstinence from food, or remember die poss : : :: vr 

vomiting or purging may have emptied the ^-:.5:: :-.rzT ::,:::. ' ::!:: 
of its usnal contents. 

You will also find retracted belly- wall : \-.: :.■:::: 

diseases such as caxcinoina or tnberci:' : 7 ^ :.- 

retracti(»i is associated with nmscolar :_ :. 1 _ 

pain, yon will suspect the early stage 5 

The Company expects its Examir-r :7 : .- 

with especial care in making examir : ; ::- : r^^t 

finishers, factory workers and all ap^.::- ;;:t .z .:..}..- 

with paints, varnishes, oik, dost, et: : = '7:-: .7- re- 

tractions of the behy-wall in cases 'T't : r : . - -- r : : 

Separate diagnostically the S'- : .. t :; t t , : : : : r : 

that due to ascites by the fact that in :; - : , t : t t ; _ : : - 

trium is moderately fiat when the 7?^: 7 : -^ :. v . . t - .: 

tympanites is present it is more pr : : : . . ; ^ : . r : : : . : t :- : - r' ^ - - - 



INSTRUCTIONS TO MEDICAL EXAMINERS. 19 

est bulging is generally to be found in the flanks, or if the patient 
sits or stands erect the hypogastric region bulges from the change 
in the position of the fluid. In ascites due to free liquid in the 
abdominal cavity, percussion will elicit dullness or flatness over the 
flank and resonance only where the intestines are floated up against 
the anterior belly-wall above the effusion. Palpation will also reveal 
fluctuation in ascites, but none in lymphatic distention. 

As a result of the gradually increased intra-abdominal pressure, 
the floating ribs become pressed outward, the apex-beat of the heart 
is often displaced upward and outward, and the umbilicus becomes 
protruded instead of retracted. The skin of the belly-wall becomes 
thin and shining, and the recti muscles becoming separated enables 
the peristaltic movements of the intestines to be readily felt through 
the intervening skin. 

In many of these cases you will find the frequent cause of an 
accumulation of fluid in the diaphragm is cirrhosis of the liver which 
results in engorgement of the abdominal vessels with secondary 
transudation of fluid. If it be not due to cirrhosis, you will suspect 
an abdominal tumor, which by pressing on large vessels results in 
an effusion of liquid through their walls, or tubercular peritonitis, 
or obstruction of the thoracic duct, or valvular disease of the heart 
causing an obstruction to the flow of blood in the vena-cava, and 
finally, acute diffuse or chronic parenchymatous nephritis. If the last 
two causes be present there will usually be oedema of the lower 
extremities or general anemia with dyspnoea and albuminuria. 

The Genital Organs. 

The genital organs should be inspected very carefully. Note 
any signs of previous specific trouble, also whether there be present 
varicocele or hydrocele, or any evidence of rupture. Also carefully 
inspect the rectum for piles, fissures, abscess, stricture, etc. 

Personal History. 

If the personal history shows any record of blood spitting, 
the Examiner cannot be too careful to record in detail everything 
pertaining thereto, as it is only after a careful study that we are able 
to distinguish accurately between attacks which may be safely dis- 
regarded and those which constitute decided impairment. You 
should, therefore, dift'erentiate between true hemoptysis and the 
blood stain sputum of pneumonia, or a severe bronchitis or a hem- 
orrhage of the nose or throat. In all cases the cause, the number 
of attacks and the extent of each hemorrhage must be recorded. 



20 THE NORTHERN LIFE INSURANCE CO. OF ILLINOIS. 

Also note particularly as to gout and rheumatism. Repeated 
attacks, of course, are of much greater significance than a single 
attack, therefore, be careful to give the number of attacks and the 
date of each, and indicate whether severe or not, and whether or 
not there were any serious complications. It is also very necessary 
to distinguish between articular and the so called muscular rheu- 
matism. 

In cases of rheumatism examine the heart very carefully; en- 
quire into number, duration, severity of attacks, and whether heart 
was involved, how recent the last attack and whether confined to bed 
or house. 

Hernia being admitted as existing or found to exist calls for a 
thorough examination to determine its character and see that a 
proper truss is worn with no danger of protrusion on exertion. If 
truss is not or cannot be worn, determine whether hernia is re- 
ducible, and if not, why not. If double hernia exists, explicitly so 
state. 

Syphilis should never be referred to as a chancroid. Have in 
mind that one is simply a local and the other a constitutional disease. 
Give date and character of primary lesion, character and duration 
of secondary or tertiary lesion, the treatment employed and when dis- 
continued. Syphilitic risks are decidedly sub-standard, consequently 
require to be studied with extra care. 

Ascertain very carefully from the applicant whether he has 
found it necessary to consult a physician for any ailment, if so, give 
the name and address of the physician, nature of ailment and date 
of treatment. 

Dimensions. 

The height of the applicant and the dimensions of the chest 
and abdomen should be carefully measured and not estimated. 
This is very important. The weight should be taken without coat 
or vest, and where for any reason it is necessary to estimate 
the word "estimated" should be inserted along with the figures, 
otherwise the Company assumes the weight to be exact. It 
is very important to ascertain whether the applicant has recently 
gained or lost weight, and especially in the case of loss the cause 
should be carefully investigated, for the Medical Examiner well 
knows that frequently the first manifestation of tuberculosis is loss 
of weight. 

Abdominal measurements should be taken on a level with the 
umbilicus with male applicants, and at the waist with females, and 
if the abdomen be unduly prominent, state these facts with the prob- 
able cause. 



INSTRUCTIONS TO MEDICAL EXAMINERS. 



21 



TABLE OF HEIGHTS AND WEIGHTS 

Light-face figures are 20 per cent under and over the average. An 
appHcant showing a variation from the average greater than 20 per 
cent will not, as a rule, be regarded as acceptable. 


Ages 


45-24 


25-29 


30-34 


35-39 


40-44 


45-49 


50-54 

107"" 
134 

161 


55-60 


Ft. 
5 


In. 



96 
120 

144 


100 
125 

150 


102 
128 

154 


105 
131 

157 


106 
133 

160 

107 
134 

161 


107 
134 

161 


107 
134 

161 




1 


98 
122 

146 


101 
126 

151 


103 
129 

155 
105 
131 

157 


105 
131 

157 


109 
136 

163 


109 
136 

163 


109 
136 

163 




2 


99 
124 

149 


102 
128 

154 


106 
133 

160 


109 
136 
163 
111 
139 
167 


110 
138 

166 


110 
138 

166 
113 
141 

169 


110 
138 

166 




3 


102 
127 

152 


105 
131 

157 


107 
134 

161 


109 
136 

163 


113 
141 

169 


113 
141 

169 
116 
145 
174 
119 
149 
179 




4 


105 
131 

157 


108 
135 

162 


110 
138 

166 


112 
140 

168 


114 
143 

172 


115 
144 

173 


116 
145 

174 




5 


107 
134 

161 


110 
138 

166 


113 
141 

169 
116 
145 
174 
120 
150 
180 

123 
154 

185 
127 
159 

191 


114 
143 

172 


117 
146 

175 
120 
150 

180 


118 
147 

176 


119 
149 

179 




6 


110 
138 

166 


114 
142 

170 


118 
147 

176 


121 
151 

181 


122 
153 

184 


122 
153 

184 




7 


114 
142 

170 


118 
147 

176 


122 
152 

182 


124 
155 

186 


125 
156 

187 


126 
158 

190 


126 
158 
190 
130 
163 
196 
134 
168 
202 




8 


117 
146 

175 


121 
151 

181 


126 
157 

188 


128 
160 

192 


129 
161 

193 


130 
163 

196 
134 
167 

200 

138 
172 

206 




9 


120 
150 

180 


124 
155 

186 


130 
162 

194 


132 
165 
198 
136 
170 
204 


133 
166 

199 




10 


123 
154 

185 


127 
159 

191 


131 
164 

197 


134 
167 

200 

138 
173 

208 


137 
171 

205 


138 
173 

208 




11 


127 
159 

191 


131 
164 

197 


135 
169 

203 


140 
175 

210 


142 
177 

212 


142 
177 

212 


142 
178 

214 


6 





132 
165 

198 


136 
170 

204 


140 
175 

210 


143 
179 

215 


144 
180 

216 


146 
183 

220 


146 
182 

218 


146 
183 

220 




1 


136 
170 

204 


142 
177 

212 


145 
181 

217 


148 
185 

222 


149 
186 

223 


151 
189 

227 


150 
188 

226 


151 
189 

227 




2 


141 
176 

211 


147 
184 

221 


150 
188 

226 


154 
192 

230 


155 
194 

233 


157 
196 

235 


155 
194 

233 
161 
201 

241 


155 
194 

233 




3 


145 
181 

217 


152 
190 

228 


156 
195 

234 


160 
200 

240 


162 
203 

244 


163 
204 

245 


158 
198 

238 



22 THE XORTHERX LIFE IX5UR.\XCE CO. OF ILLIXOIS. 

Do not trust to the opinion of the appHcant in regard to height 
and weight. Always measure the height, and if the stature be 
notably short, explain the cause, whether due to dwarf like habit 
of the body, or disease of the spine. Both extremes in stature are 
unfavorable. 

If the applicant is not well proportioned be sure to have him 
weighed. If markedly above average weight, state whether he is 
of a large, bony frame, with tlie flesh well distributed and firm; 
look into his family characteristics, habits, occupation, and state 
whether there is a tendency to obesitv* ; observe his complexion, 
whether it is pale, sallow or flabby in appearance. Ascertain the 
cause and report it. 

If the applicant is materially BELOW average weight, the 
Examiner should look for the cause, and unless it is a family char- 
acteristic it will be found that there is some disturbance in nutrition, 
or a diseased condition. There must be a cause and that cause 
must be reported. If there is a recent rapid gain or loss in weight, 
the cause of this must be ascertained. 

Family History. 

The recording of the family history is of vital importance. 
Satisfy yourself as to the exact facts and record them as concisely 
as possible. Where the final illness of any member of the family 
has been a protracted one, you should determine definitely whether 
death was due to tubercular disease. 

An accurate family historv' is absolutely essential if anything 
is discovered in the personal historv' or present condition of the 
applicant to arouse suspicion of hereditary predisposition to disease. 
Should the applicant state that the condition of health of any living 
relative is "feeble." "moderate." or "poor," give the reason for so 
stating and inquire regarding cough, consumption or other con- 
stitutional disease. 

Seek always as regards the cause as well as the date of death 
of parents, brothers, or sisters, and grandparents to ascertain the 
specific disease or most probable cause of death, especially where 
there may be a suspicion of consumption. This is always important 
when the parents have died young or at middle Hfe. 

The Company will not accept such answers as ''General De- 
bility," "Exposure," "Effects of Cold," "Child Birth," "Change of 
Life," "Fever," "Don't Know," etc., unless careful inquiry indicate 
that they are correct. 

We have found that a large portion of the deaths ascribed by 
applicants to such causes will, if properly investigated, be found 



INSTRUCTIONS TO MEDICAL EXAMINERS. 23 

to be due to consumption; and this cause may fairly be assumed 
whenever such deaths have been preceded by a lengthy illness. 

Also carefully report whether insanity, apoplexy or other hered- 
itary diseases have appeared in applicant's grand-parents, parents, 
brothers or sisters. 

Build. 

Builcl should also be carefully noted, whether it is an individual 
or a family characteristic; when the applicant is markedly over or 
under weight the heights and weights of other members of the 
family should be ascertained. 

Signature. 

The Medical Examiner should note carefully the signing of the 
answers to him, and if applicant's signature is tremulous, ascertain 
and record the reason thereof. Be careful to distinguish between 
the irregular, jerky signature of one who is unaccustomed to the 
use of the pen and the uniformly tremulous signature of a subject 
having functional or organic disease of the nervous system. 

Appearance. 
In your answer as to the general appearance, complexion, etc., 
take pains to give as correct a picture as possible. If the applicant 
is of a stooping, round shouldered or flat-chested figure, of feeble 
or delicate look, pale or unhealthy complexion, express this in ap- 
propriate terms. 

Occupation. 

The occupation of the applicant should be positively ascertained ; 
whether he is engaged or likely to be engaged in an occupation in- 
volving unusual hazard or confinement in dusty or ill-ventilated 
rooms, or in cramped or unhealthy postures, exposure to sudden 
variations of temperatures, etc., and especially whether he is or has 
been engaged in the manufacture, selling or personal handling of 
alcoholic liquors. 

Habits. 

The habits of the appHcant are of great importance to this 
Company, and the Examiner does not do his full duty to the Com- 
pany who does not place us in possession of all unfavorable informa- 
tion which may be accessible to him. If personally acquainted with 
the applicant, you should be able to give all the facts. If not ac- 
quainted and you have reason to suspect evasion, you must not de- 
pend upon his statements, but secure further information through 
mutual acquaintances. If the case is at all suspicious, determine 
whether or not he has ever undergone treatment for the liquor or 
drug habit; if so, give date and result of treatment. Applicants 



24 THE XORTHERX LIFE IXSUBAXCE CO. OF ILLINOIS. 

who are addicts of the opium, chloral, cocaine or liquor habit will 
not be accepted by this Company. 

Examiner's Report, 
All examinations must be made in private and in no case is the 
agent to be given the findings of tlie examining physician. Both 
the recording of the answers of the appHcant and your report must 
be made entirely in your own handwriting, and where corrections 
are made, you should indicate tliat they are made by yourself b}' 
adding 3'our initials. You must not fill in any part of the applica- 
tion blank itself. Applications and medical examiner's reports will 
not be accepted by this Company if the Examiner is related to either 
applicant or agent. 

THE ^lAIX POINTS. 

He-\rt. 

Always remember the condition of the heart is of great impor- 
tance. ^^llen the radial pulse is noniial in frequency, of sufficient 
strength and volume, and perfectly regular, the apex-beat in the 
fifth interspace within the mammar}* line, and no murmurs present, 
the heart is presumably sound. Any departure from this standard 
must be carefully noted, and whether any o&dema of the feet and 
legs is present, or any degenerative changes in arteries, togetlier 
with an opinion as to the proper cause. 

Pulse. 

Again, in regard to the pulse, the rate should be quietl}' taken 
at the wrist while the applicant is still sitting, answering questions. 
For if tlie taking be postponed until after the physical examination, 
or still worse, until after auscultation of the lungs, the normal rate 
will more hkely tlian not be considerably accelerated from excite- 
ment, conscious or unconscious. It is relatively faster in females 
and small persons, faster in youth and advanced Hfe than in middle 
age. If the rate be found out of bounds, above 88 or below 66, re- 
examination should be made to determine whether or not the ab- 
normal rate be habitual or accidental. 

Respiration. 

Again, respiration should always be taken with the appHcant at 
rest, before the physical examination, and for the same reasons that 
apply to taking the pulse. Remember if the respirations exceed 21 
per minute, some explanation is called for. 

Lungs. 

The condition of the lungs must be carefully ascertained in all 
cases. The Examiner is required to exercise the greatest caution 



INSTRUCTIONS TO MEDICAL EXAMINERS. 25 

whenever the possibiHty of consumption is suggested by the apph- 
cant's personal record, general appearance or family history. In 
such cases, besides a physical exploration of the chest, observe 
whether the chest is symmetrical and expansion uniform and equal 
on each side ; note accurately the pulse, whether accelerated or not, 
the weight, whether it is declining, and particularly if any cough 
whatever is present. If in doubt, an early evening observation of 
^he pulse and temperature must be taken. The Company will not 
accept an applicant with a cough. 

Nerves. 

During your examination, carefully observe facial expressions, 
demeanor, gesticulations, undue restlessness, tremor, gait, speech, 
etc. If these or other indications of disease of the nervous system 
are present a cause for same must be found. 

Kidneys. 

Whenever the urinary tests show the presence of albumin or 
sugar, it is absolutely necessary to examine a second specimen, or 
to make a series of examinations, and if you can, procure a sample 
of twenty-four hours' secretion. In short, conduct the examination 
as you would in a case occurring in your own private practice to 
determine, if possible, the significance of the albumin or sugar. In 
case sugar is found, it will be well for you to check your results by 
the fermentation test. 

When the specific gravity is found to be low, say under 1015, 
obtain another specimen, the authenticity of which you can vouch 
for (a specimen of applicant's urine must be taken in your presence), 
and make the usual tests for albumin. If the specific gravity should 
again be low, keep the case under observation for a period of two 
or three weeks, and examine the urine from time to time, and do 
not fail to send a sample to the medical director. 

It will be necessary to examine urine microscopically in all 
cases of $5,000.00 or over. 

Under ordinary circumstances, when an examination for an ad- 
ditional insurance is to be made, preferably the work should not be 
done by the physician who made the last examination of the appli- 
cant. 

The Business Side. 

A stated fee will be paid for each completed examination report. 
Mileage or transportation expenses are not chargeable to the Com- 
pany. An extra fee of $2.00 will be allowed for a microscopical 



26 THE NORTHERN LIFE INSURANCE CO. OF ILLINOIS. 

examination of the urine, when called for by the rule of the Com- 
pany, or when specially requested by the home office. 

Except as stated above, an application for an additional insur- 
ance does not call for another examination, unless more than thirty 
days have elapsed since the applicant was examined. No fee will 
be allowed for an examination made in violation of this rule. 

A fee of $2.00 will be allowed for re-examination by the same 
Examiner if the examination is made after thirty days, and within 
six months of the previous examination. The full fee will not be 
allowed for this service. 

An examination for a certificate of health under a lapsed policy 
must be paid for by the applicant. The fee for such services is 
not chargeable to the Company. 

Examiner's accounts are payable on the loth of each month, 
and should be sent to the home office on form No. 15, which should 
accompany each examination. 

Examiners are not permitted to make examinations outside of 
the place or district for which they are appointed, unless it be m a 
territory where there are no appointed Examiners. 

When an applicant is examined away from the town where he 
resides or has his place of business, an explanation must be made. 

An Examiner, by removal, forfeits his appointment. If his 
services have been satisfactory he may be appointed in the new lo- 
cality. 

An Examiner cannot be permitted to act as Examiner in a case 
in which he may be financially interested as an agent. 

We take this opportunity to remind you that an Examiner holds 
his appointment because of his merit, not by favor of any individual, 
and that the appointment is not in the slightest degree conditioned 
upon his taking out a policy with this Company, or upon any influ- 
ence which he may bring to bear upon others to insure. It is, of 
course, gratifying to receive an application for insurance from an 
Examiner, and to know that he does say a good word for the Com- 
pany when there is a fitting occasion. 

Finally, we would say to you that Promptness and care in the 
details of your work will contribute greatly to the success of the 
agent and the welfare of the Company, and we also assure you that 
your efforts to bring about these results will meet with hearty ap- 
preciation at the Home Office. Yours very truly, 

The Northern Life Insurance Company of Illinois. 




Medical Director. 



INSTRUCTIONS TO MEDICAL EXAMINERS. 27 

Eighteen Reasons Why You Should Insure in 
THE NORTHERN LIFE 

Because : It is a MODERN company, with a MODERN contract 
and MODERN methods. 

^Because: It is rightly founded and safely grounded. 

Because: It is founded on REFORM, recommended by the ABLE 
THINKERS and WORKERS in the Insurance field. 

Because: It is ABSOLUTELY SAFE, having entered the State 
under the Registered Contract Law, which requires approved 
securities to be deposited with the department to cover the 
reserve on every policy. The State is custodian of the funds. 
What security could be better than the State of Illinois ? 

Because : It is non-forfeitable from date of issue. 

Because: The Northern Life contract contains an Automatic Loan 
feature which provides for the payment of premiums to the 
extent of all dividends accrued or to accrue and also the 
full Loan Value on the policy, making a lapse impossible, so 
long as there are any' credits under the contract. 

Because: It is absolutely incontestable after one year. 

Because : You can convert a high-priced policy on any anniversary 
to a whole life, without loss of premiums, or re-examination, 
thus doing away with the possibility of having to lapse your 
insurance. 

Because: In converting a Guaranteed Investment policy to a 
Whole Life, the accumulated savings may be withdrawn in 
cash and a Whole Life policy carried at the age of the original 
policy. 

Because: You have thirty days' grace for the payment of any 
premium after the first. 

Because: You do not have to DIE TO WIN, as your policy may 
be settled in lo, 15, 20, 25 or 30 years. 

Because: You can borrow money on the sole security of your 
policy. 



28 THE NORTHERN LIFE INSUR_^NCE CO. OF ILLINOIS. 

Because: It insures against death, misfortune and old age, and 
every policy holder will meet OXE of these THREE. 

Because: The NORTHERN LIFE INSUIL\NCE CO]\iPANY 

of Illinois is a NEW Company, founded on the safest and 
m.ost conser^-ative basis, and will earn larger dividends tlian 
older and larger com-panies. The best dividend-earning period 
of ail companies has been during their earliest 3'ears of 
existence. 

Because: A poHcy in the NORTHERN LIFE INSURANCE 
CO]\IPANY is a legacy and not a lawsuit. 

Because: It is a Home Company, making its investments at home, 
and is building up home industries. 

Because: It pays. IT PAYS its dividends annually. 

Because: It keeps an individual Histor}- Card with each policy 
holder, keeping an open record of every dollar paid in, and 
for what it is expended. 



*90l 



